Provider Demographics
NPI:1336301514
Name:WALKER-NWARUEZE, PHILOMINA OGOCHUKWU (MBA)
Entity type:Individual
Prefix:
First Name:PHILOMINA
Middle Name:OGOCHUKWU
Last Name:WALKER-NWARUEZE
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 E COOLEY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3934
Mailing Address - Country:US
Mailing Address - Phone:909-433-0574
Mailing Address - Fax:909-433-0519
Practice Address - Street 1:1430 E COOLEY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3934
Practice Address - Country:US
Practice Address - Phone:909-433-0574
Practice Address - Fax:909-433-0519
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45953332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45953OtherHMDR
CA45953OtherHMDR